PROJECT SUMMARY/ABSTRACT While opioid misuse and opioid overdose (OD) deaths have reached pandemic levels, there is a fundamental translational gap in dissemination and implementation of evidence-based opioid OD prevention strategies, including suboptimal uptake of a pharmacy-based naloxone dispensing model. Our long-term goal is to facilitate adherence to the 2016 CDC Guidelines for safer opioid prescription practices, including strategies to mitigate risk of OD such as offering naloxone to high-risk patients and their caregivers. We plan to address this translational science need by establishing a collaborative initiative between three CTSA programs at the University of New Mexico, Tufts University, and the University of Minnesota, which incorporates engagement of community stakeholders in each state (New Mexico, Massachusetts, Minnesota). The overarching objective of this multi-CTSA collaboration is to develop and subsequently disseminate a sustainable model to increase the dispensing of naloxone by community pharmacists to patients at risk of opioid OD and their caregivers. The primary goal of this study, based on the Theory of Planned Behavior (TPB) model, is to enhance pharmacists? self-efficacy with respect to engaging in naloxone-dispensing activities and patient communication in rural and underserved areas of the U.S. We ultimately plan to disseminate our model throughout the country via the CTSA network. Guided by strong preliminary data, indicating that pharmacists experience a number of multi-level barriers that are associated with decreased dispensing of naloxone, we will work with community-engaged stakeholders in each state to carry out the following Specific Aims: 1) To identify core and state-specific elements for effective pharmacist-oriented naloxone education and develop state-specific naloxone materials for pharmacists; 2) pilot test dissemination, training, and use of pharmacist-oriented naloxone materials in six participating pharmacies from rural and under-served areas (two in each state). We hypothesize that there will be a significant increase in pharmacists? self- efficacy with respect to counseling patients about naloxone, and naloxone dispensing rates post- implementation of the pilot intervention among community pharmacists. The proposed research is innovative as it 1) focus on pharmacists as the most accessible healthcare providers in rural and medically under-served areas; 2) pilot tests a novel theory-based intervention to enhance naloxone dispensing by community pharmacists; and, 3) leverages the resources of the CTSA Consortium to address a pressing public health crisis. The proposed research is significant, because it will contribute to the field by identifying components of a stepwise and sustainable model to increase pharmacist dispensing of naloxone in rural and underserved regions of the country, and can be packaged and disseminated to similar regions across the U.S. through the CTSA network.